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OBJECTIVE: Maternal cardiac function plays a crucial role in placental function and development. The maternal hemodynamic changes in twin pregnancy are more pronounced than those in singleton pregnancy, presumably due to a greater plasma volume expansion. In view of the correlation between maternal cardiac and placental function, it is plausible that chorionicity could influence maternal cardiac function. The aim of this study was to compare the longitudinal maternal hemodynamic changes between uncomplicated dichorionic (DC) and monochorionic (MC) twin pregnancies and in comparison to singleton pregnancies. METHODS: Included in the study were 40 MC diamniotic and 35 DC diamniotic uncomplicated twin pregnancies. These were compared with a group of 294 healthy singleton pregnancies from a previous cross-sectional study. All participants underwent a hemodynamic evaluation using an Ultrasound Cardiac Output Monitor (USCOM®), at three different stages in pregnancy (11-15 weeks, 20-24 weeks and 29-33 weeks). The following parameters were recorded: mean arterial pressure (MAP), stroke volume (SV), stroke volume index (SVI), heart rate, cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), systemic vascular resistance index (SVRI), stroke volume variation, Smith-Madigan inotropy index (INO) and potential-to-kinetic-energy ratio (PKR). RESULTS: In the first trimester, DC and MC twin pregnancies showed lower MAP, SVR and PKR and higher CO and SV in comparison to singleton pregnancy. In the second trimester, maternal CO (8.33 vs 7.30 L/min, P = 0.03) and CI (4.52 vs 4.00 L/min/m2 , P = 0.02) were significantly higher in MC compared with DC twin pregnancy. In the third trimester, compared with in singleton pregnancy, women with MC twin pregnancy showed significantly higher PKR (24.06 vs 20.13, P = 0.03) and SVRI (1837.20 vs 1698.48 dynes × s/cm5 /m2 , P = 0.03), and significantly lower SV (78.80 vs 88.80 mL, P = 0.01), SVI (42.79 vs 50.31 mL/m2 , P < 0.01) and INO (1.70 vs 1.87 W/m2 , P = 0.03); these differences were not observed between DC twin and singleton pregnancies. CONCLUSIONS: Maternal cardiovascular function undergoes significant change during uncomplicated twin pregnancy and chorionicity influences maternal hemodynamics. In both MC and DC twin pregnancy, hemodynamic changes are detectable as early as the first trimester, showing higher maternal CO and lower SVR compared with singleton pregnancy. In DC twin pregnancy, the maternal hemodynamics remain stable during the rest of pregnancy. In contrast, in MC twin pregnancy, the rise in maternal CO continues in the second trimester in order to sustain the greater placental growth. There is a subsequent crossover, with a reduction in cardiovascular performance during the third trimester. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Asunto(s)

Placenta , Embarazo Gemelar , Embarazo , Femenino , Humanos , Embarazo Gemelar/fisiología , Hemodinámica/fisiología , Gasto Cardíaco/fisiología , Gemelos Dicigóticos

RESUMEN

Cardiac output (CO), along with blood pressure and vascular resistance, is one of the most important parameters of maternal hemodynamic function. Substantial changes in CO occur in normal pregnancy and in most obstetric complications. With the development of several non-invasive techniques for the measurement of CO, there is a growing interest in the determination of this parameter in pregnancy. These techniques were initially developed for use in critical-care settings and were subsequently adopted in obstetrics, often without appropriate validation for use in pregnancy. In this article, methods and devices for the measurement of CO are described and compared, and recommendations are formulated for their use in pregnancy, with the aim of standardizing the assessment of CO and peripheral vascular resistance in clinical practice and research studies on maternal hemodynamics. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Asunto(s)

Gasto Cardíaco/fisiología , Ecocardiografía/métodos , Hemodinámica/fisiología , Resistencia Vascular/fisiología , Adulto , Presión Sanguínea/fisiología , Cateterismo de Swan-Ganz/métodos , Femenino , Corazón/diagnóstico por imagen , Corazón/fisiología , Humanos , Hipertensión Inducida en el Embarazo/fisiopatología , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Embarazo , Mujeres Embarazadas , Análisis de la Onda del Pulso/métodos , Ultrasonografía Doppler/métodos

RESUMEN

OBJECTIVES: To test the efficacy of maternal activity restriction for reducing peripheral vascular resistance in normotensive pregnant women with raised total vascular resistance (TVR) and to evaluate its effect on fetal growth. METHODS: This was a prospective case-control study of 30 women enrolled between 27 and 29 weeks' gestation. All patients met the following criteria: normal blood pressure before and during pregnancy, TVR between 1300 and 1400 dynes × s/cm5 at enrolment, normal fetal Doppler parameters at enrolment and abdominal circumference between the 10th and 25th centiles. Patients were assigned to activity restriction (activity-restriction group; n = 15) or no treatment (control group; n = 15) and were assessed after 4 weeks for TVR and fetal growth. RESULTS: TVR at enrolment and estimated fetal weight centile were similar in the activity-restriction group vs controls (1358 ± 26 vs 1353 ± 30 dynes × s/cm5 ; 18th ± 4 vs 19th ± 4 centile; P = NS). After 4 weeks, the activity-restriction group compared with controls showed significantly lower TVR (1165 ± 159 vs 1314 ± 190 dynes × s/cm5 ; P < 0.05), which was associated with higher estimated fetal weight centile (25th ± 5 vs 20th ± 5 centile; P < 0.05). TVR was lower and estimated fetal weight centile higher for the activity-restriction group after 4 weeks compared with at enrolment. CONCLUSIONS: In normotensive pregnant women with raised TVR, maternal activity restriction appears to be effective in reducing TVR and therefore enhancing fetal growth. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Asunto(s)

Ejercicio Físico/fisiología , Desarrollo Fetal/fisiología , Resistencia Vascular/fisiología , Adulto , Peso al Nacer/fisiología , Estudios de Casos y Controles , Femenino , Retardo del Crecimiento Fetal/prevención & control , Edad Gestacional , Humanos , Recién Nacido , Embarazo , Estudios Prospectivos , Ultrasonografía Prenatal

RESUMEN

OBJECTIVE: To determine if hemodynamic assessment in 'low-risk' pregnant women at term with an appropriate-for-gestational age (AGA) fetus can improve the identification of patients who will suffer maternal or fetal/neonatal complications during labor. METHODS: This was a prospective observational study of 77 women with low-risk term pregnancy and AGA fetus, in the early stages of labor. Hemodynamic indices were obtained using the UltraSonic Cardiac Output Monitor (USCOM® ) system. Patients were followed until the end of labor to identify fetal/neonatal and maternal outcomes, and those which developed complications of labor were compared with those delivering without complications. RESULTS: Eleven (14.3%) patients had a complication during labor: in seven there was fetal distress and in four there were maternal complications (postpartum hemorrhage and/or uterine atony). Patients who developed complications during labor had lower cardiac output (5.6 ± 1.0 vs 6.7 ± 1.3 L/min, P = 0.01) and cardiac index (3.1 ± 0.6 vs 3.5 ± 0.7 L/min/m2 , P = 0.04), and higher total vascular resistance (1195.3 ± 205.3 vs 1017.8 ± 225.6 dynes × s/cm5 , P = 0.017) early in labor, compared with those who did not develop complications. Receiver-operating characteristics curve analysis to determine cut-offs showed cardiac output ≤ 5.8 L/min (sensitivity, 81.8%; specificity, 69.7%), cardiac index ≤ 2.9 L/min/m2 (sensitivity, 63.6%; specificity, 76.9%) and total vascular resistance > 1069 dynes × s/cm5 (sensitivity, 81.8%; specificity, 63.6%) to best predict maternal or fetal/neonatal complications. CONCLUSIONS: The study of maternal cardiovascular adaptation at the end of pregnancy could help to identify low-risk patients who may develop complications during labor. In particular, low cardiac output and high total vascular resistance are apparently associated with higher risk of fetal distress or maternal complications. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Asunto(s)

Hemodinámica/fisiología , Trabajo de Parto/fisiología , Complicaciones del Trabajo de Parto/diagnóstico , Adulto , Análisis de Varianza , Femenino , Humanos , Complicaciones del Trabajo de Parto/fisiopatología , Embarazo , Estudios Prospectivos , Curva ROC , Análisis de Regresión , Medición de Riesgo , Sensibilidad y Especificidad

RESUMEN

OBJECTIVE: To evaluate the effect on maternal cardiovascular parameters of treatment with a nitric oxide (NO) donor and plasma volume expansion in pregnancies complicated by fetal growth restriction (FGR). METHODS: Twenty-six pregnant women with a diagnosis of FGR were treated with transdermal patches of a NO donor and plasma volume expansion by co-administration of oral fluids. We compared the treated group to a historical control group of untreated FGR patients. Hemodynamic indices were obtained using the UltraSonic Cardiac Output Monitor system. RESULTS: At diagnosis, the two groups were similar in terms of maternal and hemodynamic characteristics. In the treated group, we found a significant increase in maternal cardiac output and stroke volume and a decrease in systemic vascular resistance after 2 weeks of therapy. No significant differences were found 2 weeks after diagnosis in the untreated group. The treated group delivered infants with higher birth-weight centile than did the untreated control group. CONCLUSIONS: The combined therapeutic approach of NO donor administration and plasma volume expansion in FGR apparently improves significantly maternal hemodynamic indices. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Asunto(s)

Presión Sanguínea/efectos de los fármacos , Retardo del Crecimiento Fetal/diagnóstico por imagen , Donantes de Óxido Nítrico/farmacología , Sustitutos del Plasma/administración & dosificación , Volumen Sistólico/efectos de los fármacos , Resistencia Vascular/efectos de los fármacos , Administración Cutánea , Adulto , Peso al Nacer , Presión Sanguínea/fisiología , Estudios de Casos y Controles , Femenino , Edad Gestacional , Hemodinámica/efectos de los fármacos , Humanos , Lactante , Donantes de Óxido Nítrico/administración & dosificación , Sustitutos del Plasma/farmacología , Embarazo , Estudios Prospectivos , Volumen Sistólico/fisiología , Ultrasonografía Prenatal , Resistencia Vascular/fisiología

RESUMEN

OBJECTIVES: To assess and correlate changes in body composition and haemodynamic function during pregnancy. To identify different haemodynamic profiles based on the onset of hypertensive diseases such as gestational hypertension and preeclampsia. METHODS: We enrolled 265 healthy, normotensive pregnant women throughout pregnancy (from 6+0 to 36+0weeks). They were subjected to assessment of body composition and haemodynamic function using non-invasive methods. We divided our population in three groups: group A with physiological pregnancy, group B with gestational hypertension and group C with preeclamptic patients. RESULTS: In patients who developed gestational hypertension we found lower total body water (TBW) percentage, higher Fat Mass (FM), associated with lower Cardiac Output (CO) and higher Total Vascular Resistance (TVR) during the second trimester. In the third trimester we didn't find haemodynamic differences, but a significative increase in extracellular water (ECW) percentage. In patients who developed preeclampsia we found since the first trimester significative higher TVR and hypodynamic circulation, associated with lower FM percentage. CONCLUSIONS: Assessment of body composition and maternal cardiac function may help to identify earlier in pregnancy, patients with different (mal) adaptations to pregnancy. Women with high TVR, hypodynamic circulation and low fat mass during the first trimester, might be at higher risk to develop preeclampsia. Patients with higher BMI and FM percentage, and increased TVR in the second trimester, might be at risk of gestational hypertension and excessive fluid retention at the end of pregnancy.

Asunto(s)

Composición Corporal , Hipertensión Inducida en el Embarazo/fisiopatología , Preeclampsia/fisiopatología , Trimestres del Embarazo , Diagnóstico Prenatal , Resistencia Vascular , Adulto , Gasto Cardíaco , Impedancia Eléctrica , Femenino , Humanos , Hipertensión Inducida en el Embarazo/diagnóstico , Preeclampsia/diagnóstico , Embarazo

RESUMEN

OBJECTIVE: To test if maternal hemodynamics and bioimpedance, assessed at the time of combined screening for PE, are able to identify in the first trimester of gestation normotensive non-obese patients at risk for pre-eclampsia (PE) and/or intrauterine growth restriction (IUGR). METHODS: One hundred and fifty healthy nulliparous non-obese women (body mass index < 30 kg/m2 ) in the first trimester of pregnancy underwent assessment by UltraSonic Cardiac Output Monitor (USCOM) to detect hemodynamic parameters, bioimpedance analysis to characterize body composition, and combined screening for PE (assessment of maternal history, biophysical and maternal biochemical markers). Patients were followed until term, noting the appearance of PE and/or IUGR. RESULTS: One hundred and thirty-eight patients had an uneventful pregnancy (controls), while 12 (8%) developed complications (cases). USCOM showed, in cases compared with controls, lower cardiac output (5.6 ± 0.3 vs 6.7 ± 1.1 L/min, P < 0.001), lower inotropy index (1.54 ± 0.38 vs 1.91 ± 0.32 W/m2 , P < 0.001) and higher total vascular resistance (1279.8 ± 166.4 vs 1061.4 ± 179.5 dynes × s/cm5 , P < 0.001). Bioimpedance analysis showed, in cases compared with controls, lower total body water (53.7 ± 3.3% vs 57.2 ± 5.6%, P = 0.037). Combined screening was positive for PE in 8% of the controls and in 50% of the cases (P < 0.001). After identification of cut-off values for USCOM and bioimpedance parameters, forward multivariate logistic regression analysis identified as independent predictors of complications in pregnancy the inotropy index (derived by USCOM), fat mass (derived from bioimpedance analysis) and combined screening. CONCLUSIONS: Combined screening for PE and assessment of bioimpedance and maternal hemodynamics can be used to identify early markers of impaired cardiovascular adaptation and body composition that may lead to complications in the third trimester of pregnancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Asunto(s)

Impedancia Eléctrica , Hemodinámica/fisiología , Preeclampsia/diagnóstico , Primer Trimestre del Embarazo/fisiología , Ultrasonografía Prenatal/métodos , Adulto , Biomarcadores/análisis , Presión Sanguínea , Composición Corporal , Gasto Cardíaco , Estudios de Casos y Controles , Femenino , Humanos , Embarazo , Resistencia Vascular

RESUMEN

OBJECTIVE: To evaluate the maternal hemodynamic profile in women with a diagnosis of threatened preterm delivery (TPD) in order to understand the possible pathophysiologic mechanism leading to an increased lifetime risk for future cardiovascular disease. METHODS: Patients with a diagnosis of TPD were enrolled and assessed using a non-invasive method (USCOM® ) for the determination of hemodynamic parameters. Vaginal and rectal swabs were taken, cervical length, blood inflammatory indices, fetal blood-vessel Doppler velocimetry were measured and gestational age at the time of delivery and neonatal outcomes were noted. RESULTS: A total of 68 patients were enrolled and included in the analysis. The population was divided into two groups according to total vascular resistance (TVR): Group A with a TVR of ≤ 1000 dynes × s/cm5 (n = 48) and Group B with a TVR of > 1000 dynes × s/cm5 (n = 20). C-reactive protein (CRP) was higher in Group B than in Group A, suggesting a systemic inflammation status. Group B delivered earlier (32 + 4 weeks vs 38 + 2 weeks; P < 0.01) and neonatal outcome was worse than in Group A. Significantly lower values of cardiac output, stroke volume, peak velocity of flow, velocity time integral, minute distance, stroke volume index, cardiac index, stroke work, cardiac power, inotropy index and potential-to-kinetic energy ratio were observed in Group B than in Group A. CONCLUSIONS: Women with a diagnosis of TPD showing TVR values of > 1000 dynes × s/cm5 and elevated levels of CRP are at high risk of preterm delivery. An impaired maternal cardiovascular adaptation during pregnancy in these patients might suggest a possible higher risk for subsequent future cardiovascular disease. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Asunto(s)

Trabajo de Parto Prematuro/epidemiología , Nacimiento Prematuro/epidemiología , Resistencia Vascular , Adulto , Proteína C-Reactiva/metabolismo , Enfermedades Cardiovasculares , Femenino , Corazón/fisiopatología , Hemodinámica , Humanos , Edad Materna , Embarazo , Factores de Riesgo , Volumen Sistólico

RESUMEN

INTRODUCTION: Maternal cardiovascular system adapts to pregnancy, thanks to complex physiological mechanisms that involve cardiac output, total vascular resistance and water body distribution. Abnormalities of these adaptive mechanisms are connected with hypertensive disorders. OBJECTIVE: To identify patients at a high risk of developing hypertensive complications of pregnancy during the first trimester of pregnancy, through the use of non-invasive methods such as USCOM (Ultrasonic Cardiac Output Monitor) and Bioimpedance. MATERIALS AND METHODS: We enrolled 120 healthy normotensive women during the first trimester of pregnancy obtaining all measurements with the USCOM system and Bioimpedance. RESULTS: 20 patients were excluded for a bad USCOM signal. The remaining patients (n = 100) were retrospectively divided into two groups: Group A (n = 75) TVR<1200 dynes s cm(-5), Group B (n = 25) TVR>1200 dynes s cm(-5). No statistically significant difference was identified in terms of water distribution, Fat Free Mass, Systolic/Diastolic Blood Pressure, Heart Rate, Hematocrit, Flow Time Corrected and Water Balance Index between the two groups. In contrast, higher values of the Cardiac Output, Stroke Volume, Fat Mass and Inotropy Index have been highlighted in the Group A. Moreover, in the Group A we found a better maternal-neonatal outcome and a lower incidence of hypertensive complications. CONCLUSIONS: High TVR during the first weeks of gestation may be an early marker of cardiovascular maladaptation more than the evaluation of water distribution and, in particular, with respect to the single blood pressure assessment. Moreover lower values of Inotropy Index could be an indicative of the worst cardiac performance.

Asunto(s)

Agua Corporal/fisiología , Preeclampsia/fisiopatología , Resistencia Vascular/fisiología , Adulto , Presión Sanguínea/fisiología , Impedancia Eléctrica , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Hipertensión Inducida en el Embarazo/fisiopatología , Preeclampsia/prevención & control , Embarazo , Primer Trimestre del Embarazo/fisiología , Estudios Prospectivos , Volumen Sistólico/fisiología

RESUMEN

OBJECTIVES: Most studies during pregnancy have assessed maternal left ventricular (LV) function by load-dependent indices, assessing only chamber function. The aim of this study was to assess afterload-adjusted LV myocardial and chamber systolic function at 24 weeks' gestation and 6 months postpartum in high-risk normotensive pregnant women. METHODS: A group of 118 high-risk women with bilateral notching of the uterine arteries underwent an echocardiographic examination to evaluate midwall mechanics (midwall shortening (mFS%) and stress-corrected midwall shortening (SCmFS%)) of the LV at 24 weeks' gestation and 6 months postpartum. Patients were followed until delivery and pregnancies were classified retrospectively as uneventful (uncomplicated outcome) or complicated. A control group of 54 low-risk women with uneventful pregnancies without bilateral notching was also enrolled. RESULTS: The pregnancy was uneventful in 74 (62.7%) women, whereas 44 (37.3%) developed complications. At 24 weeks' gestation, mFS% and SCmFS% were greater in the uncomplicated-outcome compared with the complicated-outcome group (25.9 ± 4.8 vs 18.8 ± 5.0%, P < 0.001 and 107.9 ± 18.4 vs 77.9 ± 20.7%, P < 0.001, respectively). At 6 months postpartum, SCmFS% remained greater in the uncomplicated-outcome compared with the complicated-outcome group (100.4 ± 21.6 vs 87.8 ± 19.1, P < 0.05). In the uncomplicated-outcome group, SCmFS% was higher during pregnancy than it was postpartum, whereas in the complicated-outcome group, it was lower during pregnancy than it was postpartum (P < 0.05). CONCLUSIONS: Maternal cardiac midwall mechanics appear to be enhanced (SCmFS% increased compared with controls) during pregnancy compared with postpartum in high-risk patients with uncomplicated pregnancy, whereas midwall mechanics are depressed both during pregnancy and postpartum in patients with pregnancy complications.

Asunto(s)

Ecocardiografía/métodos , Ventrículos Cardíacos/fisiopatología , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Placenta/diagnóstico por imagen , Arteria Uterina/diagnóstico por imagen , Adulto , Velocidad del Flujo Sanguíneo , Presión Sanguínea , Femenino , Edad Gestacional , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Hipertrofia Ventricular Izquierda/fisiopatología , Recién Nacido , Placenta/irrigación sanguínea , Placenta/fisiopatología , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnóstico por imagen , Complicaciones Cardiovasculares del Embarazo/fisiopatología , Resultado del Embarazo , Embarazo de Alto Riesgo , Índice de Severidad de la Enfermedad , Volumen Sistólico , Arteria Uterina/anomalías , Arteria Uterina/fisiopatología

RESUMEN

OBJECTIVE: Complications in early-onset mild gestational hypertension (GH) are better predicted by total peripheral vascular resistance (TPVR) > 1350 dyne than by blood pressure. We therefore aimed to assess the possible reduction of severe complications by lowering TPVR with nitric oxide (NO) donors, oral fluids and standard antihypertensive therapy in women with early-onset mild GH. METHODS: A group of 400 patients with early-onset (20-27 weeks' gestation) mild GH (systolic and diastolic blood pressure < 170/110 mmHg) and TPVR > 1350 dyne were enrolled in a prospective non-randomized trial with sequential allocation: 100 patients were treated with nifedipine (Group A); 100 with nifedipine and NO donors (Group B); 100 with nifedipine and oral fluids (Group C); and 100 with nifedipine, NO donors and oral fluids (Group D). TPVR was checked 1 month after initiation of therapy, and the number of patients with severe maternal and fetal complications was recorded in each group. The relationship between reduction in TPVR and the frequency of severe complications was assessed. RESULTS: Severe complications developed in 51% of patients in Group A, 48% in Group B, 53% in Group C and 35% in Group D, the frequency in Group D being significantly lower than that in the other treatment groups (P < 0.05). A reduction in TPVR of < 15% predicted the occurrence of severe complications with sensitivity 95.2% and specificity 88.3%. In Group D a reduction in TPVR of ≥ 15% was more probable (odds ratio (OR) = 2.03; 95% CI, 1.15-3.60; P < 0.015) and severe complications were less probable (OR = 0.52; 95% CI, 0.29-0.91; P < 0.023). CONCLUSION: In women with early-onset mild GH, combined treatment with NO donors, oral fluids and nifedipine optimally reduces TPVR and seems to reduce maternal and fetal complications.

Asunto(s)

Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Hipertensión Inducida en el Embarazo/tratamiento farmacológico , Nifedipino/uso terapéutico , Donantes de Óxido Nítrico/uso terapéutico , Resistencia Vascular/efectos de los fármacos , Adulto , Antihipertensivos/farmacología , Ecocardiografía , Femenino , Humanos , Persona de Mediana Edad , Nifedipino/farmacología , Donantes de Óxido Nítrico/farmacología , Embarazo , Estudios Prospectivos , Resultado del Tratamiento , Ultrasonografía Prenatal , Adulto Joven

RESUMEN

OBJECTIVES: To report the antenatal pictures of a fetus with multiple intracranial lipomas. METHODS: A 36-year-old primigravida, 33 weeks of gestation, was referred to our ultrasound laboratory due to sonographic suspicion of an intracranial hemorrhage. RESULTS: At 2D and 3D ultrasound imaging, three separated round-shaped hyperechoic intracranial masses compatible with multiple lipomas were documented. Absence of corpus callosum was associated. Sonographic findings were confirmed by antenatal and postnatal MRI. CONCLUSIONS: Multiple intracranial lipomas in a fetus with absent corpus callosum have been infrequently described. Prognostic implications remain uncertain.

Asunto(s)

Neoplasias Encefálicas/diagnóstico por imagen , Lipoma/diagnóstico por imagen , Ultrasonografía Prenatal , Adulto , Neoplasias Encefálicas/patología , Femenino , Humanos , Recién Nacido , Lipoma/patología , Imagen por Resonancia Magnética , Embarazo

RESUMEN

OBJECTIVE: To evaluate the effect of plasma volume expansion (PVE) and nitric oxide (NO) donors, in addition to antihypertensive therapy for gestational hypertensive pregnancies complicated by intrauterine growth restriction (IUGR) with absent end-diastolic flow (AEDF) in the umbilical artery (UA). METHODS: This was a case-control study into which 32 gestational hypertensive pregnancies with IUGR and AEDF were enrolled. Sixteen of these were treated with antihypertensive drugs, NO donors and PVE (Group A), and 16, matched for maternal age, gestational age and fetal conditions, were treated with antihypertensive drugs only (Group B). All patients underwent fetal and uteroplacental assessment and maternal echocardiography to evaluate total vascular resistance (TVR) and cardiac output before and 5-14 days after initiation of treatment. RESULTS: After 5-14 days of treatment, the maternal TVR in Group A fell from 2170 +/- 248 to 1377 +/- 110 dynes.s.cm(-5) (P < 0.01), and that in Group B fell from 2090 +/- 260 to 1824 +/- 126 dynes.s.cm(-5) (P < 0.01), with the reduction being greater in Group A than in Group B (P < 0.01). There was a significant increase in cardiac output in Group A after 5-14 days of treatment vs. baseline (6.19 +/- 0.77 vs. 4.32 +/- 0.66, P < 0.001), and, after treatment, cardiac output was significantly greater in Group A than it was in Group B (6.19 +/- 0.77 vs. 4.70 +/- 0.44, P < 0.001). Reappearance of end-diastolic flow in the UA occurred in 14/16 patients in Group A but in no patients in Group B (87.5% vs. 0%, P < 0.05). The interval between detection of UA-AEDF and delivery was 28 +/- 16 days in Group A and 11 +/- 6 days in Group B (P < 0.05). CONCLUSION: Administration of NO donors and PVE in gestational hypertensive pregnancies affected by IUGR and UA-AEDF appears to improve both maternal and fetal hemodynamics, inducing prolongation of gestation.

Asunto(s)

Antihipertensivos/uso terapéutico , Retardo del Crecimiento Fetal/diagnóstico por imagen , Hipertensión Inducida en el Embarazo/tratamiento farmacológico , Donantes de Óxido Nítrico/uso terapéutico , Arterias Umbilicales/diagnóstico por imagen , Adulto , Antihipertensivos/administración & dosificación , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Velocidad del Flujo Sanguíneo/fisiología , Estudios de Casos y Controles , Dihidralazina/administración & dosificación , Dihidralazina/uso terapéutico , Ecocardiografía Doppler/métodos , Femenino , Hemodinámica/efectos de los fármacos , Hemodinámica/fisiología , Humanos , Donantes de Óxido Nítrico/administración & dosificación , Circulación Placentaria/efectos de los fármacos , Circulación Placentaria/fisiología , Volumen Plasmático/fisiología , Embarazo , Arterias Umbilicales/anomalías

RESUMEN

OBJECTIVE: To evaluate the prognostic impact of elevated total vascular resistance (TVR) on the outcome of pregnancy in early mild gestational hypertension (EMGH). DESIGN: Prospective observational study. SETTING: Data collected from women with EMGH referred to the obstetrics outpatient clinic of Tor Vergata University from June 2003 to June 2005. POPULATION: A total of 268 women with EMGH (systolic and diastolic blood pressure [BP] 140-150 mmHg and 90-99 mmHg, respectively, without significant proteinuria). METHODS: Women had a maternal echocardiographic examination and BP examination within 24 hours of diagnosis. From this, the TVR was calculated and the geometric pattern of the left ventricle assessed. MAIN OUTCOME MEASURES: Fetal/maternal adverse outcomes (pre-eclampsia, preterm delivery, placental abruption, other maternal medical problems, fetal distress, neonatal low birthweight, admittance to neonatal intensive care unit and perinatal death). RESULTS: Ninety-two out of the 268 pregnancies showed adverse outcomes (34.3%). The best independent predictor for the composite of maternal and fetal complications was TVR (OR 64.4, 95% CI 25.9-160.1). The cutoff value was 1340 dyn seconds/cm(5) with a sensitivity and a specificity of 90 and 91%, respectively. Concentric geometry of the left ventricle was also an independent predictor (OR 4.72, 95% CI 1.85-12.04). CONCLUSIONS: Echocardiography could help in identifying women with EMGH who subsequently develop maternal and fetal complications, allowing a classification in high-risk (TVR > 1340 dyn seconds/cm(5), concentric geometry of the left ventricle) and low-risk women (TVR < 1340 dyn seconds/cm(5), nonconcentric geometry of the left ventricle) for adverse outcomes of pregnancy.

Asunto(s)

Hipertensión Inducida en el Embarazo/diagnóstico , Resistencia Vascular/fisiología , Desprendimiento Prematuro de la Placenta/prevención & control , Adulto , Cardiomiopatías/patología , Estudios de Casos y Controles , Ecocardiografía Doppler , Femenino , Retardo del Crecimiento Fetal/prevención & control , Humanos , Hipertensión Inducida en el Embarazo/fisiopatología , Variaciones Dependientes del Observador , Trabajo de Parto Prematuro/prevención & control , Embarazo , Complicaciones Cardiovasculares del Embarazo/patología , Resultado del Embarazo , Estudios Prospectivos , Ultrasonografía Prenatal/métodos

RESUMEN

OBJECTIVE: To assess the differences in fetal body compartments between fetuses with normal growth and those with reduced intrauterine growth, during the third trimester, through ultrasonographic determination of subcutaneous tissue thickness (SCTT). METHODS: Twenty-eight patients were enrolled into this case control study carried out at 30-31 weeks' gestation. Two study groups were matched for maternal age and pregestational body mass index: controls (n = 14) and intrauterine growth-restricted (IUGR) fetuses (n = 14). Routine ultrasound-derived biometric parameters (head circumference, abdominal circumference, femur length and humerus length) were measured. Additionally, the mid-arm fat mass and lean mass (MAFM and MALM), the mid-thigh fat mass and lean mass (MTFM and MTLM), the abdominal fat mass (AFM) and the subscapular fat mass (SSFM) were measured. The Mann-Whitney U-test and Student's t-test were used to compare the two groups. RESULTS: The abdominal circumference and the humerus were significantly smaller in IUGR fetuses than in controls. Most of the SCTT values were different in the two groups. The SSFM (3.6 +/- 1.1 vs. 2.6 +/- 0.7 mm; P = 0.011), the AFM (5.1 +/- 0.7 vs. 4 +/- 1 mm; P = 0.01), the MAFM (3.5 +/- 0.9 vs. 2.2 +/- 0.8 cm2; P < 0.01) and MALM (2.1 +/- 0.4 vs. 1.7 +/- 0.5 cm2; P = 0.029) were all significantly greater in fetuses with normal development compared to those with growth restriction. CONCLUSIONS: During the third trimester, SCTT (with the exception of MTFM and MTLM) is reduced in fetuses with IUGR. Furthermore, MALM is lower in growth-restricted fetuses, confirming that the parameters measured in this study are affected in IUGR fetuses. Our findings indicate that specific changes in fetal body compartments occur as a result of chronic metabolic impairment.

Asunto(s)

Composición Corporal , Retardo del Crecimiento Fetal/diagnóstico por imagen , Abdomen/diagnóstico por imagen , Abdomen/patología , Tejido Adiposo/diagnóstico por imagen , Tejido Adiposo/patología , Adulto , Antropometría/métodos , Peso al Nacer , Estudios de Casos y Controles , Femenino , Retardo del Crecimiento Fetal/patología , Humanos , Húmero/diagnóstico por imagen , Húmero/patología , Recién Nacido , Embarazo , Tejido Subcutáneo/diagnóstico por imagen , Tejido Subcutáneo/patología , Ultrasonografía Prenatal/métodos

RESUMEN

Pregnancy is considered to be a hypercoagulable state per se with an increased risk for cerebrovascular events, however cerebellar infarction has been rarely described in pregnant women. A nulliparous pre-eclamptic woman at 25 weeks' gestation was submitted to an echocardiographic exam that showed an impaired cardiac structure and function. After 2 h, the patient underwent caesarean section for diagnosis of haemolysis, elevated liver enzymes, low platelet (HELLP) syndrome. Afterwards her platelet count raised, and eight days later she developed nystagmus, ataxia, dysmetria and motor deficit in the right limbs and sensory impairment in the right side of the face and in the left limbs. Cerebral magnetic resonance imaging (MRI) demonstrated a right cerebellar and median posterior bulbar infarction. Colour-coded sonography of cerebral vessels showed an occlusion of the right vertebral artery. Coagulation pattern analysis evidenced double heterozygosis of the methylenetetrahydrofolate reductase (MTHFR) gene and single mutation of the prothrombin gene. This case report gives evidence of the importance of considering the different risk factors involved in stroke occurrence during pregnancy.

Asunto(s)

Infarto Encefálico/etiología , Enfermedades Cerebelosas/etiología , Cerebelo/fisiopatología , Síndrome HELLP/complicaciones , Preeclampsia/complicaciones , Adulto , Infarto Encefálico/patología , Infarto Encefálico/fisiopatología , Infartos del Tronco Encefálico/etiología , Infartos del Tronco Encefálico/patología , Infartos del Tronco Encefálico/fisiopatología , Enfermedades Cerebelosas/patología , Enfermedades Cerebelosas/fisiopatología , Cerebelo/irrigación sanguínea , Cerebelo/patología , Femenino , Predisposición Genética a la Enfermedad/genética , Síndrome HELLP/metabolismo , Síndrome HELLP/fisiopatología , Humanos , Imagen por Resonancia Magnética , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Preeclampsia/metabolismo , Preeclampsia/fisiopatología , Embarazo , Protrombina/genética , Factores de Riesgo , Insuficiencia Vertebrobasilar/etiología , Insuficiencia Vertebrobasilar/patología , Insuficiencia Vertebrobasilar/fisiopatología